valacyclovir and Drug-Overdose

Topics: Academic Medical Centers; Accidents, Home; Acyclovir; Adult; Antiviral Agents; Boston; Combined Modality Therapy; Diagnosis, Differential; Drug Overdose; Emergency Service, Hospital; Fellowships and Scholarships; Female; Humans; Medical Staff, Hospital; Neurotoxicity Syndromes; Prodrugs; Status Epilepticus; Toxicology; Treatment Outcome; Valacyclovir; Valine; Workforce; Young Adult

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Crystallization; Drug Overdose; Humans; Male; Middle Aged; Uric Acid; Valacyclovir; Valine

We report three cases of neurotoxicity in patients with renal failure, treated with Zelitrex (valacyclovir).. The patients are two women and a man, aged 76 +/- 4.6 years, who presented acute mental confusion during a treatment with valacyclovir. In two cases, the patients previously had altered renal function and were under peritoneal dialysis. In the last case, the patient had simultaneous neurotoxicity and acute renal failure. After the discontinuation of the drug, the outcome was favourable in all cases.. Our cases focus attention on the possible neurotoxicity of valacyclovir, which is an amino acid ester prodrug of acyclovir, rapidly and almost completely hydrolysed to acyclovir prior to systemic exposure. The bioavailability of valacyclovir is 54% compared to approximately 20% for oral acyclovir and may account for unexpected overdoses, which may lead to serious neurological toxicity.

Topics: Acyclovir; Aged; Aged, 80 and over; Biological Availability; Drug Overdose; Female; Humans; Male; Mental Disorders; Prodrugs; Renal Insufficiency; Valacyclovir; Valine